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Warning on MRI use in treating breast cancer

Fri, Oct 22, 2010, 01:00

EITHNE DONNELLAN

SOME WOMEN are undergoing unnecessary mastectomies as a result of the inappropriate use of MRI scans in the treatment of early stage breast cancer, a leading surgeon has said.

Malcolm Kell, consultant breast surgeon at Dublin’s Mater Hospital, said if MRI scans were used to examine small lumps in a woman’s breast after an initial mammogram she was more likely to have the breast removed without any ensuing benefits to her health.

He said two recent studies in the UK and the US had shown some women certainly had undergone needless mastectomies. The Comice study in the UK, published earlier this year, looked at about 1,600 women with early stage breast cancer, half of whom had an MRI scan and half of whom were managed without one. Those who had undergone an MRI scan were six times more likely to have had a mastectomy but there was no difference in the outcomes of both groups.

When more MRI scans were used in women with early stage breast cancer at the Mayo Clinic, in the United States, it increased the numbers having a mastectomy by 10 per cent, without any benefits being demonstrated.

Asked if unnecessary mastectomies were also being carried out in the Republic after MRI scanning in early stage breast cancer he said: “Hopefully not, but there is always a risk.”

He stressed, however, that a combination of highly skilled radiologists and multidisciplinary team meetings made unnecessary mastectomies less likely here.

Mr Kell’s caution in relation to the use of MRI for early stage breast cancer, appears in an editorial in the latest edition of the
British Medical Journal. He also points out that MRI is still very important in the treatment of breast cancer, especially in patients who present with secondaries and efforts are being made to find the primary tumour; to gauge the response to chemotherapy; and in patients known to be at high risk of breast cancer and have a genetic abnormality which predisposes them to developing breast cancer.

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But he warns the use of this technology in early stage breast cancer may do more harm than good. This could be because MRI is so sophisticated it picks up harmless recurrence or extension of tumours whose removal will not alter the patient’s prognosis.